Pharmacy Benefits Manager Pharmacy Benefits Managers Application Supporting Documents Notification Requirements References Relevant Bulletins Pharmacy Benefits Managers Alaska Statute AS 21.27.010 License Required sets forth the general requirement for a PBM to be licensed in Alaska. Further provisions under AS 21.27.901 state that: A person may not conduct business in the state as a pharmacy benefits manager unless the person is licensed with the director. The Pharmacy Benefits Manager application can be submitted online with NIPR.com. The application fee is $20,000. A PBM is required to designate a compliance officer. This person is not required to be separately licensed. A PBM that is unable to apply online should supply the Pharmacy Benefits Manager application. A credit card invoice can be requested at the time of submission. The application and any supporting documents should be emailed to: insurancelicensing@alaska.gov Application Supporting Documents: All Pharmacy Benefits Managers are required to submit the following supporting documentation with their initial application: All basic organizational documents of the Pharmacy Benefits Manager, including articles of incorporation, articles of association, articles of organization, partnership agreement, trade name certificate, trust agreement, shareholder agreement and other applicable documents and all endorsements to the required documents. Bylaws, operating agreement, rules, regulations and similar documents regulating the internal affairs of the benefits manager. The names, mailing addresses, physical addresses, official positions and professional qualifications of persons who are responsible for the conduct of affairs of the Pharmacy Benefits Manager, including the compliance officer, members of the board of directors, members of the limited liability company or partnership, board of trustees, executive committee or other governing board or committee, the principal officers in the case of a corporation or the partners or members in the case of a partnership or association, shareholders holding directly or indirectly 10 percent or more of the voting securities of the Pharmacy Benefits Manager and any other person who exercises control or influence over the affairs of the Pharmacy Benefits Manager. Certified (audited) financial statements for the prior two years prepared by an independent certified public accountant that establish that the applicant is solvent, that the applicant's system of accounting, internal control and procedure is operating effectively to provide reasonable assurance that money is promptly accounted for and paid to the person entitled to the money. If the applicant submits a consolidated statement, a consolidating worksheet for the applicant must also be included A statement describing the business plan including information on staffing levels and activities proposed in this state and in other jurisdictions and provide details establishing the Pharmacy Benefits Manager’s capability for providing a sufficient number of experienced and qualified personnel in the areas of claims handling, underwriting, and record keeping • Identify the key personnel who supervise or have responsibility over personnel performing Pharmacy Benefits Manager functions If this information is not submitted to the NIPR Attachment Warehouse, our office will reach out requesting the information. Supporting documentation can be submitted to: insurancelicensing@alaska.gov Notification Requirements Under AS 21.27.904 a PBM operating in Alaska is required to notify the Division within 30 days of any of the following: A licensed pharmacy benefits manager shall notify the director in writing not later than 30 days after a change in the information contained within the licensee's license, place of business, electronic mailing address, physical mailing address, or telephone number; a change in compliance officer, residence, place of business, mailing address, or telephone number; the final disposition of an administrative action taken against the licensee by a governmental agency of another state, by a governmental agency of another jurisdiction, or by a financial industry regulatory authority sanction or arbitration proceeding; in addition, a licensee shall submit to the director documents relating to the final disposition on, including the final order and other relevant legal documents in, the action; or a conviction of a misdemeanor or felony of the pharmacy benefits manager, its officers, designated compliance officer, directors, partners, or owners. Statutes and References Article X. Pharmacy Benefits Managers. AS 21.27.630-AS 21.27.660 Relevant Bulletins B25-09